Nursing discussion topics

Discussion Topics, Chapter 27, General and Local Anesthetic Agents:

1. Sally, a 3-year-old, will be undergoing a tonsillectomy and you will be providing postoperative care. Sally’s mother mentions that the anesthetist had stated that a balanced approach to anesthesia would be used

.a. Explain the term balanced anesthesia and describe the agents involved

.b. Describe the nursing considerations and care required by a patient receiving general anesthetics.

2. The course instructor has assigned your group to explain-the uses/methods of local anesthetics.

a. Explain the difference between field block and a nerve block.

b. What are the key nursing considerations for patients receiving a field block or nerve block?

c. Discuss the five types of nerve blocks mentioned in your book.

d. Identify nursing considerations that should be implemented for all patients receiving general or local anesthetics.


Discussion Topics, Chapter 28, Neuromuscular Junction Blocking Agents:

1. Ms. Smith is scheduled for electroconvulsive therapy today. She has a history of narrow-angle glaucoma. You have been assigned to care for Ms. Smith during this clinical rotation.

a. Which neuromuscular junction blocking agent would you expect to be used during the procedure: succinylcholine or tubocurarine? Defend your answer.

b. Explain the difference in depolarizing and nondepolarizing neuromuscular junction blockers.

2. You are observing in the pediatric ICU and have been assigned to follow a 5-year-old who is mechanically ventilated and receiving vecuronium to prevent spontaneous respiratory effort and muscle relaxation.

a. What special nursing care considerations should this patient receive?

b. The patient is currently receiving gentamycin for an infection and aminophylline for wheezing. What are the potential implications of combining the medications with vecuronium?


Discussion Topics, Chapter 29, Introduction to the Autonomic Nervous System:Objective(s)

1. Your small group has been assigned the task of discussing the key concepts of the autonomic nervous system in 5 minutes or less and using only one or two sentences. In order to be successful, your group must answer the following questions:

a. What makes the autonomic nervous system unique?

b. What is the sympathetic response?

2. You are completing a service learning project that involves teaching middle school students about the parasympathetic nervous system. Due to time constraints, you have only 10 minutes to present your topic, and the students will be required to answer questions based on the information you present.

a. What happens when the parasympathetic nervous system is stimulated?

b. Explain the muscarinic receptors and the nicotinic receptors.

3. Students may work in small groups or answer individually. Compare and contrast alpha1-receptors and beta2-receptors.


Discussion Topics, Chapter 30, Adrenergic Agonists:

1. Ms. Jones is an 80-year-old in the critical care unit receiving treatment for shock. She is currently receiving Dopamine at 10 mcg/kg/min and Dobutamine at 10 mcg/kg/min with a stable blood pressure and heart rate. Currently, she is not able to interact with family or the health care team. Her medical history includes mild heart failure and mild hypertension, which are treated with oral medications. She has many family members with her, including a son who is using the Internet to gather information on her medications.

a. The son asks why his mother is on dopamine and dobutamine when they are the same medication. How do you answer his question?

b. If the dopamine and dobutamine reach the maximum therapeutic range, what medication would you anticipate adding to help maintain blood pressure, heart rate, and tissue perfusion?

2. Mr. Jones has been prescribed phenylephrine drops for his glaucoma. He calls the clinic very upset that the drops burn his eyes. After careful questioning, Mr. Jones admits that he was not willing to pay for prescription eye drops and decided to use the over-the-counter nasal drops because they are the same drug.

a. What patient teaching is essential in the situation?

b. Explain the differences in how phenylephrine is used to treat glaucoma and shock.

3. A child has been prescribed the adrenergic agonist Albuterol to be taken at home.

a. What teaching is essential to provide to the parents who may seek over-the-counter allergy and cold preparations for their child?


Discussion Topics, Chapter 31, Adrenergic Blocking Antagonists:

1. Mr. Rodriguez is a 50 year old male with diabetes. He has been diagnosed with hypertension and congestive heart failure and is prescribed carvedilol (Coreg) 6.25 mg orally b.i.d.

a. What are the key teaching points for Mr. Rodriguez about carvedilol?

b. Explain why carvedilol is better than guanadrel to treat Mr. Rodriguez for his combined hypertension and congestive heart failure.

2. Mr. Caraglione has been taking betaxolol 20 mg orally daily to treat his hypertension. He arrives for a routine follow-up and expresses dissatisfaction because he feels weak, dizzy, and tired when taking the drug.

a. What adjustments can be made to help Mr. Caraglione deal with the adverse effects of betaxolol?

b. Further investigation has determined that Mr. Caraglione’s symptoms have increased since he started taking ginseng. What are the drug-drug interactions for patients taking ginseng and betaxolol?


Discussion Topics, Chapter 32, Cholinergic Agonists:

1. James is 10 years old with a history of spina bifida. He has been performing self-catheterizations for the last 2 years. During his last clinic visit, he was started on bethanechol for neurogenic bladder.

a. How does bethanechol treat neurogenic bladder?

b. What are the adverse effects of bethanechol and other direct-acting cholinergic agonists?

2. Mrs. Smith has myasthenia gravis and will be switching from neostigmine to pyridostigmine to help with compliance. She is concerned about missing doses and taking the medication correctly.

a. What are some dosing concerns with pyridostigmine, and what are the key teaching points?

b. Mrs. Smith is scheduled for a follow-up diagnostic exam using edrophonium. Explain how edrophonium is used in diagnosing myasthenia gravis.


Discussion Topics, Chapter 33, Anticholinergic Agents:

1. Mr. Jackson is an African American man who will undergo eye surgery for a torn retina. The ophthalmologist has ordered ophthalmic atropine drops for mydriasis prior to the procedure.

a. What are the key nursing considerations when administering mydriatics to patients with dark-pigmented eyes?

b. What teaching will Mr. Jackson need related to postoperative mydriasis?

2. Mrs. Nguyen is planning a vacation cruise and is concerned about motion sickness. She has been prescribed a scopolamine patch.

a. Explain the proper method for applying a transdermal patch.

b. What are the potential adverse effects of a scopolamine transdermal patch?


Discussion Topics, Chapter 34, Introduction to the Endocrine System:

1. Your small group has been assigned the topic of hormones for a 2-minute presentation.

a. List the most common characteristics of all hormones.

b. Why are hormones important to normal cell function?

2. The topic for postclinical conference is the negative feedback system within the endocrine system and the hypothalamic-pituitary axis.

a. Explain the negative feedback system and how it works within the endocrine system.

b. Why is the hypothalamic-pituitary axis important for hormone regulation?

Discussion Topics, Chapter 35, Hypothalamic and Pituitary Agents:

1. Shalonda, 5 years old, has received a diagnosis of precocious puberty and will be taking histrelin (Supprelin) 400 mcg SC every morning.

a. Histrelin helps regulate the production of which hormone?

b. How does histrelin treat precocious puberty?

2. Mrs. James has been diagnosed with diabetes insipidus and will be started on nasal DDAVP.

a. What is diabetes insipidus, and what hormone is involved in this condition?

b. What is the mechanism of action for DDAVP?

c. How should the nurse instruct Mrs. James to administer the DDAVP?d. Discuss the adverse effects that may occur.

Discussion Topics, Chapter 36, Adrenocortical Agents:

1. Bernard has been placed on a beclomethasone (Beclovent) to be taken as a respiratory inhalant q.i.d. He is newly diagnosed with asthma and very concerned about taking steroids.

a. What type of steroid is beclomethasone, and what are the therapeutic actions of this type of steroid ?

b. What are the most common adverse effects for clients taking inhaled beclomethasone?

2. Mrs. Jones has been diagnosed with bronchitis, and hydrocortisone (Cortef) has been added to her medication regimen to treat inflammation. You have been assigned to care for Mrs. Jones during clinical.

a. What are the key nursing concepts when implementing hydrocortisone therapy?

b. After receiving corticosteroids for a prolonged period of time, explain the pathophysiology for discontinuing the medication slowly.

c. What are the most common adverse effects of systemic corticosteroids?

Discussion Topics, Chapter 37, Thyroid and Parathyroid Agents:

1. The nurse is caring for Mrs. Smith, a 55-year-old patient who has been started on levothyroxine for hypothyroidism.

a. Describe the symptoms of hypothyroidism.

b. How does levothyroxine help correct hypothyroidism?

c. What are the adverse effects for a woman Mrs. Smith’s age taking levothyroxine?

2. Mrs. Jolon is 60 years old and in excellent overall health. The results of her first bone scan indicate the beginning of postmenopausal osteoporosis. She will begin taking calcitriol (Rocaltrol) daily.

a. What other interventions would you recommend for Mrs. Jolon to improve her bone density and prevent osteoporosis?

b. Explain how osteoporosis occurs and who is at the greatest risk to develop it.

Discussion Topics, Chapter 38, Agents to Control Blood Glucose Levels:

1. A group of nursing students have been assigned a presentation during postclinical conference on the pathophysiology of diabetes mellitus and why diabetics must take insulin.

a. List five key bullet points about the pathophysiology of diabetes mellitus.

b. Explain in three bullet points how insulin helps the body.

2. Ms. Jones is 60 years old and obese. She has been diagnosed with type 2 diabetes and will be started on glyburide. She is very nervous about this diagnosis and concerned that she will need to give herself shots.

a. Explain the difference between diabetes mellitus type 1 and type 2.

b. How does glyburide help decrease blood sugar levels?

c. What are the key teaching points for patients taking oral antidiabetic agents?

Discussion Topics, Chapter 40, Drugs Affecting the Female Reproductive System:

1. Ms. James is seen in the clinic today for evaluation of menopause symptoms. She is requesting hormone replacement therapy and reports currently taking a red clover herbal therapy.

a. What are the risks and benefits of hormone replacement therapy (HRT)?

b. Many women use herbal or alternative therapies for treating adverse symptoms of menopause. What teaching will Ms. James need about combining herbal treatments and HRT?

2. Sally is 32 years old and considering using fertility drugs for pregnancy. She and her husband have been attempting to conceive for approximately a year. She is interested in learning about clomiphene (Clomid), which helped her sister conceive.

a. How does clomiphene improve a woman’s attempts to conceive?

b. What are the adverse effects associated with fertility drugs?

Discussion Topics, Chapter 41, Drugs Affecting the Male Reproductive System:

1. Mr. Smith is a 30-year-old with chronic renal failure who has suffered from severe anemia and is going to start on Nandrolone. He is very concerned because that is the illegal drug used by athletes.

a. How would you address Mr. Smith’s concerns about nandrolone?

b. How does nandrolone treat anemia from renal failure?

2. Mr. Jones is an 80-year-old recently married gentleman who has been screened by his primary health care provider and received a prescription for sildenafil (Viagra). He is requesting directions and information about Viagra. Develop a teaching plan that answers the following questions:

a. How does Viagra treat erectile dysfunction?

b. What are the adverse effects of Viagra?

Discussion Topics, Chapter 42, Introduction to the Cardiovascular System

1. You have been assigned to care for a patient with congential heart disease during a pediatric clinical rotation. The clinical instructor will expect you to answer the following questions:

a. Explain what occurs during diastole and systole.

b. Describe and explain the normal conduction system of the heart.

2. You have been assigned to give a 5-minute presentation on blood pressure and capillary fluid shifts.

a. Explain the factors that influence fluid shifts at the capillary level.

b. What are the four normal controls for blood pressure regulation?

Discussion Topics, Chapter 43, Drugs Affecting Blood Pressure

1. Mr. Tinsley is a 55-year-old lawyer who has been diagnosed with primary hypertension. The health care provider has informed the patient that lifestyle modifications must be made. He is prescribed captopril (Capoten) 25 mg PO b.i.d and hydrochlorothiazide.

a. The nurse is providing drug information to Mr. Tinsley when he asks the therapeutic action of ACE inhibitors.

b. What lifestyle modifications should the nurse instruct Mr. Tinsley to make?

c. What adverse effects should the nurse monitor in this patient?

2. Mr. Tinsley returns to the clinic 1 month later for reevaluation. His blood pressure is 140/72 and he is complaining of an irritating cough. The health care provider discontinued the ACE inhibitor and started on diltiazem (Cardizem, Dilacor CR).

a. Explain why only the ACE inhibitor was discontinued.

b. How does diltiazem treat hypertension?

c. Mr. Tinsley says that his BP is really not that high so why does he really need this medication. How should you respond?

3. The nurse is updating the plan of care of nursing home patients with hypertension.

a. Briefly describe the therapeutic actions of drugs affecting blood pressure (diuretics, ACE inhibitors, ARBs, CCB, sympathetic nervous system drugs).

b. What important teaching points should be addressed for patients receiving antihypertensive drugs?

Discussion Topics, Chapter 44, Cardiotonic Agents

1. The nurse is caring for Mr. Adrian, an 82-year-old man with CHF who has a past medical history of diabetes and renal insufficiency. He is prescribed digoxin (Lanoxin) 0.125 mg IV and then 0.125 mg PO daily

.a. What are the therapeutic effects of cardiac glycosides?

b. Is this patient at risk for digoxin toxicity? Explain.

c. What are the adverse effects of digoxin?

d. Discuss the nursing considerations for digoxin administration.

2. Mr. Smith is a self-identified black client. He has been suffering with congestive heart failure for several years and has achieved minimal benefit from his current drug regimen. His physician recommends starting on BiDil.

a. What is BiDil?

b. Why is BiDil controversial, and what about Mr. Smith makes BiDil an attractive alternative for drug treatment?

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